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ULTRASOUND DIAGNOSIS, AND NODULE IN THYROIDITIS

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ULTRASOUND DIAGNOSIS

QUESTION  I recently had an ultrasound of my thyroid, which revealed large cystic nodule, right lobe predominately superior. measures 3.2 x 2.5 x.2.3 cm. multiple septations, some of which are thick. also appearance of mural nodule with vascularity measuring .5 cm.
also otherwise small cystic nodules, one of which shows inspissate colloid. larger of these is 5 mm and smallest is 2 mm. There is also a lymph node seen superolateral to the right lobe of the thyroid gland borderline enlarged measuring 1.2 x 1.1 x .6 cm.
anyone have any advice? I have a fna scheduled next week, but I’m dying to know in the mean time. I”ve done some reasearch and it sounds to me like papillary thyroid cancer is a good possibility. also I’m concerned since it mentions my lymph node being enlarged.
thanks

It is difficult to be accurate about a diagnosis. While thyroid cancer is a possibility, it is by no means certain.In this situation even a fna may not give the answer. It may be that you would be best advised to have thyroid surgery.
QUESTION  Thank you for your reply.  Just curious, why do you think the FNA won’t help with an accurate diagnosis.  Also, what is more worrisome, the nodule with thick septations, or the mural nodule that’s connected to it?  And does the enlarged lymph node have any significance?  When I go for my FNA, will they automatically biopsy both the septated nodule as well as the mural nodule normally?  Also, I don’t know if I mentioned, the right lobe of my thyroid where all these are located is enlarge to 5.2 x 2.4 x 2.4, while the left is 4 x 1.7 x 1.1. Sorry for all these questions.  I have been thinking about this for days.  I have two small children, 2 and 4, and all I can think about is this might be cancer.
RESPONSE-  The Fna may miss an important bit in this situation. Th enlarged node may or may not be significant… not easy to say definitely.
Because your whole thyroid is multinodular I still think it needs resection and a proper hisological diagnosis. Thyroid cancer does occur in multinodular goitre but is not all that common

 

 

NODULE  in HASHIMOTO’S

QUESTION   I have been diagnosed with Hashi’s almost 5 years ago. I am 52 years old and also have idiopathic anaphylaxis and food-related anaphylaxis (IgE mediated).  I am about 50-60 lbs overweight.  have a cold nodule that has grown 10%  in the last 8 months.  The size is around 3cm.  I have been swinging from hyper to hypothyroid for the last 6 months, with no relief.  I have had trouble swallowing, hoarseness, hot flushing for up to 3 -4 hours, my basal temp runs 96+/- to 97.5, I cough for no apparent reason.  I have been short of breath for along time and have a hot and cold intolerance.  I have been having more palpitations and near panic attacks and brain fog and memory issues.   There is very little change in my TSH, etc.  If I understand it right, I guess you could say I am euthyroid.  My doctors have taken a “watch the thyroid die” kind of approach, so I have never been on any kind of thyroid meds.
My doctor recommended removing the cold nodule just to be on the safe side.  The surgeon said he would remove the whole side.  I asked him if he could remove the whole thing, since in my opinion, the hashi’s would then start attacking the remaining side relentlessly and cause more of the swing from hyper to hypo that I have been experiencing.  My doctor is out on medical leave and I have not been able to get in to see a local endocrinologist.  A second opinion from and ENT concurred with my internist.  I understand the cancer aspect is very minimal.  The ultrasound done recently doesn’t suggest any calcification or lessening of blood through the veins.
(1) If I go through with the total thyroidectomy, will my symptoms be worse, or will it be easier to control with meds since I will probably be hypo for the rest of my life.  I understand there will be remaining thyroid tissue so I will probably still have Hashi symptoms as the antibodies will always be in my system.
(2) Also, my secondary concern is triggering another autoimmune attack elsewhere.  I have tested negative for celiac disease (biopsy during colonoscopy) and had a negative test for lupus last year also (when I was losing lots of hair.)
(3) My third question is, will a TT have more of a negative impact on my health than keeping 1/2 of my thyroid?  My surgery is scheduled for 11/7.

The main risk with a TT is postopertive complications particularly with regard to calcium metabolism. In the hands of a good thyroid surgeon these risks are reduced but not totally negated
In answer to your queries
(1) Your symptoms should not be worsse provided that adequate thyroxine replacement is given. The antibodies will always be in the system although their strength (titer) declines with time.
(2) There is no evidence that the operation would trigger another autoimmune disease
(3) The answer is no it won’t